($15 individual; $25 couple)
Please make checks payable to: Retired Associates of PSU Mail to: Senior Adult Learning Center/IOA Attn: Retired Associates of PSU P.O. Box 751 Portland, OR 97207-0751 Here is my check in the amount of $___________ for membership in Retired Associates of PSU. My Name:____________________________________________________________________ Spouse's Name:______________________________________________________________ Address:_______________________________________________Apt._________________ City:________________ State:_____ Zip Code:_________ Phone:_________________ Email (Please Print): _________________________________________________________________ I would like to receive the RAPSU Newsletter by email only Yes____ No_____ (Optional) Please tell us a little bit about yourself _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ |
MEMBERSHIP FORM FOR RETIRED ASSOCIATES OF PSU |